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Rectal misoprostol vs 15-methyl prostaglandin F2
for retained placenta after second-trimester delivery
Subha Sundaram, MD; John P. Diaz, MD; Víctor Hugo González-Quintero, MD, MPH; Usha Verma, MD

OBJECTIVE: The purpose of this study was to compare rectal miso-
delivery was significantly shorter in women who received PGF2␣, com- prostol (RM) with 15-methyl prostaglandin F2␣ (PGF pared with the RM group (49.5 vs 89 minutes; P Ͻ .01). Women who agement of retained placenta after second-trimester deliveries.
received PGF2␣ had lower rates of retained placenta (4.9% vs 12.4%; STUDY DESIGN: A retrospective study of all second-trimester deliver-
ies between the years 2000 and 2005 was performed. Women were
CONCLUSION: The use of PGF2␣ after second-trimester deliveries re-
divided into 2 groups, depending on whether they received RM or sults in shorter third stage of labor and lower rates of retained placenta RESULTS: Three hundred three second-trimester deliveries were ana-
Key words: misoprostol, prostaglandin F2␣, retained placenta, lyzed. The time from the administration of medications to the placental Retained placenta is a significant thirdstageoflaborhavefocusedonterm awaitedfor30minutes.Attheattend-
ing physician’s discretion, if the pla- placed rectally or 250 ␮g of PGF2␣ was received PGF2␣, if placenta did not de- prostaglandin F2␣ (PGF2␣) in the man- agement to facilitate the delivery of the retained placenta is a safe alternative that MATERIALS AND METHODS
been investigated for use in the control of From the Department of Obstetrics andGynecology, University of Miami, Miller Presented at the 55th Annual Clinical Meeting of The American College of Obstetricians and Gynecologists, San Diego, CA, May 5-9, 2007.
Received July 6, 2008; revised Sept. 19, 2008; ery of the fetus to the administration of duration of induction was defined as the Authorship and contribution to the article is soprostol to the delivery of the fetus. The limited to the 4 authors indicated. There was third stage of labor was defined as the no outside funding or technical assistance with time from the delivery of the fetus to the time of placental delivery, either sponta- neously or by instrumental removal. In- 2009 Mosby, Inc. All rights reserved.
strumental removal was defined as the re- moval of the placenta with a ring forceps e24 American Journal of Obstetrics & Gynecology MAY 2009
Maternal demographics
15-methyl PGF2
RM (n ؍ 161)
(n ؍ 142)
P value
Sundaram. RM vs 15-methyl PGF2for retained placenta after 2nd trimester delivery. Am J Obstet Gynecol 2009. taneous placental delivery. Li and reported 100% success with the use of800 ␮g of RM in the delivery of the delivery of the fetus and were not eligi- analyzed with the Student’s t-test. Cate- goric variables were analyzed with the ␹2 means of the Statistical Packages for the of PGF2␣ over RM is not clear exactly, we value of Ͻ .05 was considered to be sta- speculate that it may be related to phar- macokinetics of rectal administration.
Meckstroth et in their study on drug other routes. Also, our rates of retained sion of the fetus, and missing data.
labor and lower rates of instrumental re- with the rates quoted by other authors.
Leader et had reported a higher inci-dence (26%) of curettage in their study.
Outcome measures
timal time for instrumental removal ina woman with retained placenta who 15-methyl PGF2
RM (n ؍ 161)
(n ؍ 142)
P value
Sundaram. RM vs 15-methyl PGF2for retained placenta after 2nd trimester delivery. Am J Obstet Gynecol 2009. PGF2␣ for retained placenta after second- MAY 2009 American Journal of Obstetrics & Gynecology
trimester deliveries results in shorter third stage of labor and reduced rates of instru- 3. Li YT, Yin CS. Delivery of retained placenta by
6. Meckstroth KR, Whitaker AK, Bertisch S,
misoprostol in second trimester abortion. Int J Goldberg AB, Darney PD. Misoprostol adminis- tered by epithelial routes: drug absorption and REFERENCES
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